Rate and Clinical Predictors of Malignancy in Thyroid Nodules with Indeterminate Cytology

Background: Fine needle aspiration cytology (FNAC) cannot differentiate between benign and malignant conditions in cytologically indeterminate thyroid lesions. Therefore, a minimum of diagnostic lobectomy is required for definitive diagnosis. The objective of this study is to identify the rate of malignancy and clinical features that may possibly predict malignancy in patients with these lesions, in Ethiopian hospitals. Methods: This was a retrospective review of the medical records of patients who underwent surgery for cytologically indeterminate thyroid lesions in three referral hospitals between September 2015 and September 2020. Results: Of 85 patients with indeterminate cytology findings, 56 (63.5%) were follicular, and 29 (34.1%) were reported to be hurthle cell neoplasms. Follicular lesions of undetermined significance (FLUS) and suspicious for follicular neoplasm were each reported in single cases (1.7%). Malignant disease was diagnosed in 19 (22.4%) of patients. A follicular variant of papillary cancer was detected in 7 (11.5%) patients. Hard nodule consistency was reported in 9 of 11 malignant lesions and 5 of 66 benign lesions. In multivariate binary logistic regression, hard nodule consistency was found to be associated with malignancy (P = 0.012, AOR = 7.28 (1.5, 34.54) 95% CI ). The ill-defined surface of a nodule was found to be associated with malignancy though the association was not statistically significant (P = 0.088, AOR = 0.162 (0.020, 1.313) 95% CI. Ultrasound evaluation of thyroid nodule was performed only in 41 (47.7%) of patients. Conclusion: The rate of malignancy in thyroid nodules with indeterminate cytology was 22.4%. The risk of malignancy was higher in patients with hard thyroid nodule consistency and ill-defined surface. Despite the established benefits of ultrasound for the evaluation of thyroid nodules, the current practice of its use in our setup is suboptimal. Keywords: Follicular; hurthle cell; indeterminate cytology; predictors of malignancy

Wandering spleen with torsion presenting as a rare case of acute abdomen

Wandering spleen is a rare clinical occurrence characterized by the absence of spleen in its normal anatomic place. Patients may present with acute abdomen, abdominal mass, and chronic abdominal pain. Prompt diagnosis and intervention are necessary. Here, we report a case of a woman who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. Keywords: Wandering spleen; torsion; splenectomy

En-bloc excision of Giant Cell Tumors of the distal radius and arthrodesis of the translocated ipsilateral ulna: A report of two cases

The distal radius is the third most common site of giant cell tumor of bone (GCTB). The local aggressive invasion of this rare neoplasm requires reconstructive solutions after wide excision. The authors present two cases of patients diagnosed with Campanacci grade III GCTB of the distal radius successfully treated with en-bloc excision and translocation of the ipsilateral ulna. Pre-operative application of denosumab was given for one year to both patients. At one year of follow-up, both patients are disease-free and reported satisfactory results on Quick - Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and modified Musculoskeletal Tumor Society (MSTS) score. Although a challenge, the reported procedure offers good oncological and functional outcomes. Keywords: Giant cell tumor of bone; distal radius; en-bloc excision; translocation; ipsilateral ulna; wrist arthrodesis

Proximal epithelioid sarcoma of the vulva: A case report and review of the literature

Primary sarcomas of the vulva are rare, with an incidence of 1.5% to 5% of all vulvar malignancies. There are only 41 cases described in the English literature of proximal epithelioid sarcoma of the vulva, which also constitutes a highly aggressive neoplasm with a high rate of recurrence and metastasis. We are reporting the first case of vulvar epithelioid sarcoma reported in our country, Peru, and Latin America. We present the case of a 53-year-old woman with no significant history who presented a large tumor mass of 25 cm in the left hemivulva of 2 years of evolution, associated with intense pain. She underwent radical surgical resection with left inguinopelvic lymphadenectomy and reconstruction of Rectus Abdominal Muscle Myocutaneous Flaps (TRAM).

A perspective of extremity vascular trauma epidemiology and its management in a resource limited set up

Background: Extremity vascular injuries are one of the major causes of limb loss and potentially preventable deaths after trauma. Although it is a major challenge, especially in countries with a less established trauma center, early diagnosis, and intervention are important for a better outcome. The aim of this study was to describe the epidemiology, management strategies, and outcomes of extremity vascular trauma in the Ethiopian setting. Methods: A retrospective observational study was conducted among all extremity vascular trauma patients who were admitted and treated at Tikur Anbessa Specialized Hospital (TASH) Between June 2015 and May 2020. Result: A total of 85 patients with extremity vascular trauma, predominantly male (90.6%), were included in the study. The mean age was 27 ± 9 years. Penetrating trauma caused 89.4% of extremity vascular injuries. The majority of the injuries are caused by stab/sharp (40%), bullet (29.4%) and road traffic accidents (17.7%). The brachial artery was the commonest vessel injured accounting for 36.5% followed by femoral artery injury of (22.4%). The commonest types of vascular injuries were complete transection (74.1%), laceration (15.3%), and partial transection (8.2%). The most commonly used method of vascular reconstruction was reverse interposition venous graft accounting for 45.9%. Other methods were ligation & hemostasis (20%), primary repair with End-to-End Anastomosis (17.7%), primary simple repair (15.3%), and venous patch (1.2%). A limb salvage rate of 91.8% was achieved despite a 67.1% of late presentation (>6 hours). Conclusion: Vascular injuries are mainly due to violence and road traffic accidents. Limb loss and mortality due to this injury can be mitigated by improving health policies, implementing emergency ambulatory systems, and provision of vascular services with better training centers.

Management of acute sigmoid volvulus in a tertiary hospital north central nigeria: The place of advanced radiodiagnostics

Background: Volvulus involves the twisting of an air-liquid stool-filled thin-walled segment of an intestine around its necessarily narrow mesenterial base, thereby strangulating the blood vessels, which often causes necrosis of this redundant intestinal segment. Intestinal volvulus had always been supposed to be a disease of the blacks from West African and the Bushmen natives of South Africa. The West African subset became the index region. Surgery was the best treatment for the full-blown disease. Conservative methods of management have only just been developed and studied in the Scandinavian countries. Scandinavian early rectosigmoidoscopic reductions of the twisted colonic segment have offered some valuable alternative helps. Methods: We studied the documents of all the 44 patients who had a presumptive diagnosis of acute or subacute colonic volvulus and were admitted to surgical management. Biostatistics, exact history taking of the patients, carefully structured physical examination, and a good digital scout X-ray investigation of the abdomen helped to make a rapid diagnosis. Laparotomies confirmed such a diagnosis. We did not regularly attempt to do recto-sigmoidoscopic untwisting of the volvuli. All had Hartmann’s procedure surgeries with terminal colostomies. Results: Of the 41 patients admitted to surgical management, 31 were males and 10 were females with a ratio of 3:1. The timing of surgery influenced mortalities and morbidities greatly. Conclusion: The diagnosis of acute volvulus was simple. We needed to record the medical history, took the proper physical examination, correctly explained the examination results, and only studied the abdominal X-ray film without resorting to advanced computer tomography.

Predictors of relaparotomy for persisting intra abdominal infection in secondary peritonitis

Background: Peritonitis is one of the commonest causes of acute abdomen in Ethiopia. One of the causes of high morbidity and mortality is persistent intraabdominal infection. The two essential approaches for managing post-op collection are laparotomy on-demand and planned Relaparotomy. Despite multiple studies, both have comparative mortality. This study aimed to identify clinical variables that are predictive of persistent intraabdominal infection. Methods: A retrospective study was conducted on patients who were operated on from Sept 2018 to April 2020 at two affiliated referral hospitals of AAU, college of Medicine; Yekatit 12 hospital Medical College and Minilik II referral Hospital. All of the patients were cases of secondary peritonitis. Clinical progress of the patients from admission to discharge/death was documented. Multiple preoperative and intraoperative variables were analyzed to develop the predictive clinical model. Results: Out of 172 laparotomy cases for secondary peritonitis, 40 (23.3%) required relaparotomy for postop collection. From Patients who developed postop collection, 45% of them were diagnosed after pus/Gi content leaked through the surgical wound. The mortality rate of patients who develop postop collection and undergone relaparotomy was 27.5 % and 4.5% for those without postop collection. Logistic regression identified 4 variables as having significant predictive value: Duration of illness more than 5 days, Systolic BP 1000 ml, and small bowel as a source of contamination. Overall prediction successes of the above model is 88.4% (sensitivity 53.3%, specificity 96.8%). Conclusion: Management of persistent intra-abdominal infection is challenging. We have identified 4 clinical variables that predict persistent intraabdominal infection requiring relaparotomy. These sets of variables can be a milestone for future validation study before being inserted in today to day clinical practice.

The Value of Hounsfield Unit in Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy for the Treatment of Renal Stone of 2-3 cm: A Single-center Prospective Pilot Study

Background: To determine whether the Hounsfield Unit (HU) value of no-contrast computer computed tomography (NCCT) might offer better guidance in the selection of RIRS or PCNL in renal stones of 2-3 cm. Methods: A total of 158 patients with kidney stones (2-3 cm) who underwent PCNL/RIRS from March 2016 to January 2019 were enrolled in this study. Age, gender, stone sizes, locations, average HU value of stones, surgery time, hospital stay time, stone-free rate, and complications at the time of hospitalization and 3-month follow-up were measured to identify the surgery efficiency. Results: Upon consideration of the HU value, the mean surgery time was significantly decreased in RIRS comparing to the control RIRS (cRIRS) group (47.73 ± 15.52 vs. 72.41 ± 27.71 min, P < 0.05). Statistically, the surgery time was strongly influenced by the HU values both in RIRS (OR 93.8, P < 0.01) and PCNL (OR 8.21, P < 0.05). HU values proved to have a strong positive relation with surgery time in RIRS while a low positive relation in PCNL (P < 0.05). Conclusion: Overall, for renal stones of 2-3 cm, RIRS might be a safe and efficacious treatment option if the HU value and other parameters could be comprehensively accounted for. Individual precision surgery might provide ideal treatment and prognosis for patients requiring long-term continuous clinical procedures.

Genital self-mutilation or similar suicide in a schizophrenic, the second attempt was dramatic

Genital auto-mutilation is a urological emergency rarely encountered in practice. It constitutes a drama by its manner of occurrence and clinical presentation. In case of heavy bleeding, a state of hemorrhagic shock may occur and require resuscitation. the treatment is based on surgery and psychiatric advice. a regular follow-up with an attentive intention is needed to avoid the recurrency. We are reporting a 29-year-old patient followed for schizophrenia with poor compliance who is attempting genital auto-mutilation for the second time. The first attempt resulted in shallow wounds, but the second attempt was dramatic: it resulted in genital amputation. Keywords: Penis, external genital organs, mutilation, amputation, schizophrenia